Download ICBO 2011 Chute

Biomedical Informatics
Some Observations on
Clinical Data Representation in EHRs
Christopher G. Chute, MD DrPH, Mayo Clinic
Chair, ICD11 Revision, World Health Organization
Chair, ISO Tech. Comm. TC215 Health Informatics
International Conference on Biomedical Ontology
Buffalo, 30 July 2011
Biomedical Informatics
From Practice-based Evidence
to Evidence-based Practice
Data
Patient
Encounters
Decision
support
Clinical
Databases
Registries et al.
Inference
Shared Semantics
Ontology
Medical Knowledge
Vocabularies & Terminologies
Expert
Systems
Clinical
Guidelines
© 2007 Mayo Clinic College of Medicine
Knowledge
Management
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Biomedical Informatics
Blois, 1988
Medicine and the nature of vertical reasoning
• Molecular: receptors, enzymes, vitamins, drugs
• Genes, SNPs, gene regulation
• Physiologic pathways, regulatory changes
• Cellular metabolism, interaction, meiosis,…
• Tissue function, integrity
• Organ function, pathology
• Organism (Human), disease
• Sociology, environment, nutrition, mental health…
© 2007 Mayo Clinic College of Medicine
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Biomedical Informatics
The Continuum Of Biomedical Informatics
Bioinformatics meets Medical Informatics
Biology
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Medicine
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Chasm of Semantic Despair
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Biomedical Informatics
The Historical Center of the
Health Data Universe
Billable Diagnoses
Clinical Data
Billable Diagnoses
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Biomedical Informatics
Copernican Healthcare
(Niklas Koppernigk)
Clinical Data
Clinical Guidelines
Billable Diagnoses
Scientific Literature
Medical Literature
Clinical Data
© 2007 Mayo Clinic College of Medicine
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Biomedical Informatics
World Health Organization; ICD-11
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Biomedical Informatics
World Health Organization; ICD-11
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Biomedical Informatics
Familiar Points Along Continuum
Modern Health Vocabularies
• Nomenclature – Highly Detailed Descriptions (SNOMED)
• Classification – Organized Aggregation of Descriptions into a Rubric
(ICDs)
• Groupings – High Level Categories of Rubrics (DRGs)
Aggregation
Nomenclature
Detailed
Groupers
Classification Groups
Grouped
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Biomedical Informatics
Aggregation Logics by domain
rule-based aggregations
Decision Support
and Error Detection
Public Health and
Surveillance
Reimbursement
and Management
Findings
Events
Interventions
© 2007 Mayo Clinic College of Medicine
Outcome Research
and Epidemiology
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Biomedical Informatics
ICD11 Use Cases
• Scientific consensus of clinical
•
phenotype
Public Health Surveillance
• Mortality
• Public Health Morbidity
• Clinical data aggregation
• Metrics of clinical activity
• Quality management
• Patient Safety
• Financial administration
• Case mix
• Resource allocation
© 2007 Mayo Clinic College of Medicine
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Biomedical Informatics
Traditional Hierarchical System
ICD-10 and family
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Biomedical Informatics
Addition of semantic arcs - Ontology
Relationships
Logical Definitions
Etiology
Genomic
Location
Laterality
Histology
Severity
Acuity
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Biomedical Informatics
Linear views may serve multiple use-cases
Morbidity, Mortality, Quality, …
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Biomedical Informatics
ICD11 Content Model
TITLE : Name of disease, disorder, or syndrome…
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1.
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9.
Textual definition 2. Synonyms - Inclusion – Exclusion - Index terms
Maintenance attributes
Descriptive characteristics
Type Disease, disorder, syndrome, injury,
A. Unique identifier
sign/symptom, external cause, reason for
B. Subset, adaptation, and
encounter
Body System(s) (pathophysiology)
special view flag
1. Primary Care
Body Part(s) (anatomical site)
2. Clinical Care
Manifestation Attributes
a. Signs & Symptoms
b. Diagnostic Findings
Causal Properties (etiology)
a. Causal Mechanisms /Agents
b. Genomic characteristics
Temporal Properties
Severity and/or Extent
Functional Impact
Treatment
3. Research
4. Special indices (e.g. Public Health
Indices or Resource Groupings)
C.
Hierarchical relationships
parents and children in ICD structure
D.
Mapping relationships
•
Linkages to other systems like
SNOMED etc.
A.
Other rules
Biomedical Informatics
Relationship with IHTSDO
SNOMED content
• IHT (SNOMED) will require high-level nodes that
aggregate more granular data
• Use-cases include mutually exclusive, exhaustive,…
• Sounds a lot like ICD
• ICD-11 will require lower level terminology for
value sets which populate content model
• Detailed terminological underpinning
• Sounds a lot like SNOMED
• Memorandum of Agreement – July 2010!
• WHO right to use for authoring and interpretation
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ICD11 and SNOMED
Biomedical Informatics
Potential Future States
SNOMED
ICD-11
Ghost ICD
Ghost SNOMED
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Biomedical Informatics
ICD-11
Joint
Alternate Future
ICD-IHTSDO
Effort
SNOMED
© 2007 Mayo Clinic College of Medicine
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